Shock

Question 1

Describe the order of events in hypovolaemic shock.

Answer 1

Loss of blood volume -> decreased blood volume -> decreased venous return -> decreased EDV -> decreased SV etc.

Question 2

What are the different types of shock?

Answer 2

Hypovolaemic, cardiogenic, obstructive e.g. tension pneumothorax, neurogenic and vasoactive (septic shock).

Question 3

What is the first step in cardiogenic shock?

Answer 3

Decreased cardiac contractility.

Question 4

Describe the steps in neurogenic shock.

Answer 4

Loss of sympathetic tone -> massive venous and arterial vasodilation -> decreased venous return and SVR -> decrease CO and MAP -> inadequate tissue perfusion.

Question 5

Describe the basic treatment for all shock.

Answer 5

ABCDE approach, high flow oxygen.

Question 6

What are the specific treatments for hypovolaemic, cardiogenic, obstructive, anaphylactic and septic shock.

Answer 6

Hypovolaemic - volume replacement. Cardiogenic - inotropes. Obstructive - chest drain. Anaphylactic - adrenaline. Septic - vasopressors.

Question 7

What are the causes of hypovolaemic shock?

Answer 7

Haemorrhage, vomiting, diarrhoea, excessive sweating.

Question 8

With how much blood loss can compensatory mechanisms still maintain compensatory mechanisms maintain blood pressure?

Answer 8

Until >30% is lost.

Question 9

Describe the ATLS classification of haemorrhagic shock.

Answer 9

I: up to 750ml, bp normal. II: 750-1500ml, bp normal. III: 1500-2000ml, bp decreased. IV: >2000ml, bp decreased.

Question 10

What compensatory mechanisms for haemorrhagic shock leads to small volume pulse and cool peripheries?

Answer 10

Increased HR via baroreceptor reflex and decreased stroke volume. Increased SVR via baroreceptor reflex.